Insulin pump therapy in adults allows metabolic control at lower rates of hypoglycemia along with reduced insulin doses – results from the nationwide DPV-survey.

Präsentation zum Thema: "Insulin pump therapy in adults allows metabolic control at lower rates of hypoglycemia along with reduced insulin doses – results from the nationwide DPV-survey."—  Präsentation transkript:

1 Insulin pump therapy in adults allows metabolic control at lower rates of hypoglycemia along with reduced insulin doses – results from the nationwide DPV-survey among German diabetes centers. EASD, Amsterdam – The Netherlands, 17 th -21 th September 2007 W. Quester 1, W. Kerner 2, E. M. Fach 3, K. Edel 4, S.Wüchner 5, K. Badenhoop 6, T. Klaes 7, H. R. Engels 8, A. Gordalla 9, H. J. Ziegelasch 10, H. R. Henrichs 11, R. W. Holl 12 1: Diabetes Center, Heart and Diabetes Center NRW, Bad Oeynhausen, Ruhr-University Bochum, Germany, 2: Klinikum Karlsburg, Klinikum Karlsburg, Karlsburg, Germany, 3: Schwerpunktpraxis, Schwerpunktpraxis, Stephanskirchen, Germany, 4: Klinik Hermannsborn, Klinik Hermannsborn, Bad Driburg, Germany, 5: Diabetes Center, Klinikum Darmstadt, Darmstadt, Germany, 6: University Clinic, University Center, Frankfurt, Germany, 7: Gemeinschaftsklinikum Koblenz-Mayen, Gemeinschaftsklinikum Koblenz-Mayen, Koblenz, Germany, 8: Krankenhaus Hellersdorf, Krankenhaus Hellersdorf, Berlin, Germany, 9: Abt. Endokrinologie Stoffwechselerkrank., Klinik für Innere Medizin Universität Rostock, Rostock, Germany, 10: Innere Medizin, Klinikum Schwerin, Schwerin, Germany, 11: Diabetes Zentrum, Christliches Krankenhaus Quakenbrück, Quakenbrück, Germany, 12: Institut für Epidemiologie, Universität Ulm, Ulm, Germany CONCLUSION Insulin requirement is significantly lower in CSII patients compared to MIT. In CSII patients the rate of severe hypoglycemia is significantly lower compared to MIT. In CSII patients the BMI is slightly higher compared to MIT. The rates of micro- and macroalbuminuria were significantly lower in CSII-patients. No significant difference in HbA1c values was detected between CSII-Therapie and MIT. Background and Aims: In adult patients with type-1 diabetes, intensified insulintherapy and insulin pump therapy are options for insulinsubstitution. Data on pump therapy under real-life- conditions in large multicenter databases are rare. Material and Methods: The DPV diabetes documentation system allows prospective documentation of parameters relevant for the process of diabetes care, as well as outcome indicators. For each individual patient, records during the most recent year were averaged. HbA1c values were mathematically standardized to the DCCT normal range. The SAS 9.2 analyses software was used for nonparametric comparisons, using Holm adjustment for multiple testing, and generalized mixed models. ACKNOWLEDGEMENT: DPV-Projekt AG Computergestütztes Qualitätsmanagement in der Medizin AGDT Arbeitsgemeinschaft Diabetologische Technologie der DDG Further information: wquester@hdz-nrw.de Results: By March 2007, data on 8483 adult subjects with type-1 diabetes (mean age 36.1± 0,2 years, range 18-88 years) were available for analysis. Gender ratio was 51% males and 49% females, the mean age at onset of diabetes was 20.2±0.2 years (mean diabetes duration 15.9±0.1 years). 6245 patients (73.6% used multiple daily injections, while 2238 (26.4%) used CSII. Diabetes duration was longer in pump patients (20.1 versus 14.3 years, p<0.0001), and more women opted for CSII (57.5% versus 45.8%, p<0.0001). Daily insulin requirement was lower in pump patients (43.9±0.4 Units compared to 53.6±0.3 Units, p<0.0001). 50.4% of subjects on multiple injections used insulin analogs, compared to 72.7% of CSII patients (p<0.0001). Mean HbA1c was 7.8% in both groups, and no difference was present after adjustment for age, duration of diabetes, gender, insulin dose, insulin preparation, degree of overweight and center heterogeneity. In contrast, the rate of severe hypoglycaemic episodes was lower in CSII patients (4.1 events per 100 patients-years) compared to MIT patients (6.6 events per 100 patient-years, p<0.0001). This difference remained significant after adjustment for potentially confounding variables (p<0.02). CSII patients were slightly more overweight with a BMI of 25.7 kg/m² compared to 24.9kg/m² in MIT patients. Diabetes-Patienten-Verlaufsdaten (DPV) on behalf of the DPV-Science Initiative DPV QS-DPV DPV-Wiss